The demographic characteristics of the participants by the type of fracture are described in Table 1. In total 478 patients were sampled, among which 178 had no history of any osteoporotic fracture. Among participants, 117, 56, and 127 patients had hip, clinical vertebrae, and forearms fracture, respectively, and 65%, 60.7%, and 74% were women, respectively. The mean and standard deviation (SD) of participants' age were 68.5 )10.7(. For patients with hip fracture, the mean age was 73.5 years and, compared to other types of fractures, they had the highest mean age. Nearly 42% of participants were unmarried and their marital status were single, divorced, and widow. About 96% of participants had basic health insurance. Around 62% of participants had at least one chronic illness in addition to osteoporosis. The mean (SD) of years of education was 6.9 (5.7). There were statistical differences between patients with and without a history of fracture in terms of sex, age, employment status, Having complementary health insurance, presence of any other chronic illness in addition to osteoporosis and years of education (P<0.05).
Table 1
Sociodemographic characteristics of the sample by type of fracture
Categorical variables | Total participants (n=478) | All fractures (n=300) | No fractures (n=178) | P-value* |
Hip Fx (n=117) | Clinical vertebral Fx (n=56) | Forearm Fx (n=127) |
n | % | n | % | n | % | n | % | n | % |
Sex |
Men | 124 | 25.9 | 41 | 35.0 | 22 | 39.3 | 33 | 26.0 | 28 | 15.7 | <0.001 |
Women | 354 | 74.1 | 76 | 65.0 | 34 | 60.7 | 94 | 74.0 | 150 | 84.3 |
Marital status |
Married | 278 | 58.2 | 53 | 45.3 | 34 | 60.7 | 79 | 62.2 | 112 | 62.9 | 0.10 |
Unmarried | 200 | 41.8 | 64 | 54.7 | 22 | 39.3 | 48 | 37.8 | 66 | 37.1 |
Employment status |
Employment | 27 | 5.6 | 6 | 5.1 | 2 | 3.6 | 9 | 7.1 | 10 | 5.6 | 0.001 |
Householder | 281 | 58.8 | 57 | 48.7 | 26 | 46.4 | 82 | 64.6 | 116 | 65.2 |
No employment | 39 | 8.2 | 15 | 12.8 | 8 | 14.3 | 13 | 10.2 | 3 | 1.7 |
Retired | 131 | 27.4 | 39 | 33.3 | 20 | 35.7 | 23 | 18.1 | 49 | 27.5 |
Having basic health insurance |
Yes | 458 | 95.8 | 116 | 99.1 | 50 | 89.3 | 119 | 93.7 | 173 | 97.2 | 0.247 |
No | 20 | 4.2 | 1 | 0.9 | 6 | 10.7 | 8 | 6.3 | 5 | 2.8 |
Having complementary health insurance |
Yes | 210 | 44.0 | 35 | 29.9 | 16 | 28.6 | 36 | 28.3 | 123 | 69.5 | -<0.001 |
No | 267 | 56.0 | 82 | 70.1 | 40 | 71.4 | 91 | 71.7 | 54 | 30.5 |
Presence of any other chronic illness in addition to osteoporosis |
Yes | 294 | 61.5 | 68 | 58.1 | 38 | 67.9 | 65 | 51.2 | 123 | 69.1 | 0.009 |
No | 184 | 38.5 | 49 | 41.9 | 18 | 32.1 | 62 | 48.8 | 55 | 30.9 |
Continues variables | | | | | | | | | | | |
Age (year), mean (SD) | 68.5 | 10.7 | 73.6 | 11.3 | 69.7 | 10.4 | 66.4 | 10.5 | 66.3 | 9.3 | <0.001 |
Years of education, Median (IQR) | 6 | 12 | 6 | 12 | 6 | 12 | 6 | 9 | 9 | 9 | <0.001 |
*Between all fractures and no fractures. Student's t-test and Mann–Whitney U-test were used for normal and non-normal distributions, respectively. |
Distribution of participants based on their answers to the EQ-5D-5L questionnaire, separated by the type of fracture, is provided in Table 2. For those with hip, vertebral, and forearm fractures, the percentage of those with “no problems” in the mobility dimension was 4.3%, 10.7%, and 30.7%, respectively. This figure for patient with no fracture was 25.3%. About 9.4% of patients with hip fractures were unable to walk. While 1.8% and 2.4% of patients with vertebral and forearm fractures, respectively, and 0% of patients with no fracture were not able to walk.
In the self-care dimension, 27.4%, 35.7%, and 48% of patients with hip, vertebral, and forearm fractures reported, “no problem” respectively, while 60.1% of patients with no fracture reported “no problem”. Besides, 6%, 1.8%, 1.6%, and 0% were not able to wash themselves or wear clothes, respectively.
Regarding the usual activities dimension, 35.9%, 39.3%, 52.8%, and 60.7% of those with the hip, vertebral, forearms fractures and those without a history of fracture had “no problem” in doing their usual activities, respectively. Besides, 6.0%, 3.6%, 0.8%, and 0.6% were unable to perform usual activities.
In the Pain/discomfort dimension 5.1%, 5.4%, 7.1%, and 12.9% of those with a history of hip, vertebral, and forearm fracture, and those without a history of fracture reported "no pain and physical discomfort", respectively. Besides, 8.6%, 14.3%, 9.5%, and 9%, respectively, noted that they had infinite pain or physical discomfort.
In terms of anxiety/depression, the percentage of those with a history of hip, vertebral, and forearm fracture and those with no history of fracture who reported "no anxiety or depression" was 35%, 26.8%, 30.7%, and 37.1%, respectively. Furthermore, 6.8%, 5.4%, 5.5%, and 6.2%, respectively, reported extreme anxiety or depression.
There were statistical differences between patients with a history of fracture, and those without a history of fracture in terms of distribution of their answers to the EQ-5D-5L questions in the mobility, self-care and usual activities dimensions (P<0.05).
Table 2
Frequency of item responses in each EQ-5D-5L dimension by type of fracture
Dimension | All fractures(n=300) | No fracture (n=178) | P-value* |
Hip Fx (n=117) | Clinical vertebral Fx (n=56) | Forearm Fx (n=127) |
n | % | n | % | n | % | n | % | |
Mobility | | | | | | | | | |
No problems | 5 | 4.3 | 6 | 10.7 | 39 | 30.7 | 45 | 25.3 | 0.001 |
Slight problems | 44 | 37.6 | 23 | 41.1 | 49 | 38.6 | 76 | 42.7 |
Moderate problems | 40 | 34.2 | 16 | 28.6 | 27 | 21.3 | 31 | 17.4 |
Severe problems | 17 | 14.5 | 10 | 17.9 | 9 | 7.1 | 26 | 14.6 |
Incapacity | 11 | 9.4 | 1 | 1.8 | 3 | 2.4 | 0 | 0.0 |
Self-care | |
No problems | 32 | 27.4 | 20 | 35.7 | 61 | 48.0 | 107 | 60.1 | <0.001 |
Slight problems | 46 | 39.3 | 21 | 37.5 | 42 | 33.1 | 48 | 27.0 |
Moderate problems | 21 | 18.0 | 10 | 17.9 | 19 | 15.0 | 19 | 10.7 |
Severe problems | 11 | 9.4 | 4 | 7.1 | 3 | 2.4 | 4 | 2.2 |
Incapacity | 7 | 6.0 | 1 | 1.8 | 2 | 1.6 | 0 | 0 |
Usual activities | |
No problems | 42 | 35.9 | 22 | 39.3 | 67 | 52.8 | 108 | 60.7 | <0.001 |
Slight problems | 32 | 27.4 | 19 | 33.9 | 33 | 26.0 | 43 | 24.2 |
Moderate problems | 24 | 20.5 | 7 | 12.5 | 18 | 14.2 | 23 | 12.9 |
Severe problems | 12 | 10.3 | 6 | 10.7 | 8 | 6.3 | 3 | 1.7 |
Incapacity | 7 | 6.0 | 2 | 3.6 | 1 | 0.8 | 1 | 0.6 |
Pain/discomfort | |
No | 6 | 5.1 | 3 | 5.4 | 9 | 7.1 | 23 | 12.9 | 0.056 |
Slight | 41 | 35.0 | 16 | 28.6 | 37 | 29.1 | 43 | 24.2 |
Moderate | 40 | 34.2 | 18 | 32.1 | 40 | 31.5 | 54 | 30.3 |
Severe | 20 | 17.1 | 11 | 19.6 | 29 | 22.8 | 42 | 23.6 |
Extreme | 10 | 8.6 | 8 | 14.3 | 12 | 9.5 | 16 | 9.0 |
Anxiety/depression | | | | | | | | | |
No | 41 | 35.0 | 15 | 26.8 | 39 | 30.7 | 66 | 37.1 | 0.408 |
Slight | 35 | 29.9 | 13 | 23.2 | 42 | 33.1 | 44 | 24.7 |
Moderate | 22 | 18.8 | 12 | 21.4 | 28 | 22.1 | 30 | 16.9 |
Severe | 11 | 9.4 | 13 | 23.2 | 11 | 8.7 | 27 | 15.2 |
Extreme | 8 | 6.8 | 3 | 5.4 | 7 | 5.5 | 11 | 6.2 |
*Between All fractures and no fractures |
The median, interquartile range (IQR), and distribution of HRQoL, measured using the EQ-5D-5L and separated by the type of fracture and sex, are provided in Table 3 and figure 1, respectively. The median (IQR) value of HRQoL scores of those with a history of hip, vertebral, and forearm fracture and no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. The HRQoL scores in women was significantly lower than men (p=0.003). |
Table 3
Median (IQR) of EQ-5D-5L scores by type of fracture
Type of fracture | All participants | Men | women | P value |
Median (IQR*) | Median (IQR) | Median (IQR) |
Hip | 0.53 (0.22) | 0.60 (0.28) | 0.52 (0.21) | 0.034 |
Clinical Vertebral | 0.60 (0.28) | 0.62 (0.12) | 0.50 (0.30) | 0.064 |
Forearm | 0.64 (0.26) | 0.67 (0.25) | 0.62 (0.24) | 0.448 |
No Fracture | 0.64 (0.27) | 0.74 (0.16) | 0.62 (0.27) | 0.002 |
Total | 0.61 (0.24) | 0.68 (0.25) | 0.59 (0.24) | 0.003 |
*IQR: interquartile range |
The mean of responses in each EQ-5D_5L dimension based on fracture types and sex are presented in figure 2. Almost in all dimension, the patients with a history of hip fracture had the highest and those without a history of fracture had the lowest mean. Furthermore, in all dimension the mean of responses were higher in women than men.
Table 4 shows the associates of the quality of life in a multiple linear regression analyses. The results showed that compared to the osteoporotic patients without history of fractures, quality of life was significantly lower in patients with hip fracture (beta= -0.077, p-value<0.001) and vertebral fracture (beta= -0.075, p-value= 0.005), but not in patients with forearm fracture (beta= -0.010, p-value: 0.611).
Being married at the time of the study had significant positive association with the quality of life (beta=0.054, p-value=0.002), while a negative association was detected between the presence of a chronic disease and quality of life in patients under study (beta= -0.033, p-value=0.039).
Women with complementary health insurance also tended to have higher quality of life, though not statistically significant (beta = 0.032, p value = 0.071).
Table 4
The associates of quality of life in the linear regression model
Independent variables | Dependent variable: utility scores | |
Coefficient | Standard Error | P-value |
Age | -0.001 | 0.001 | 0.098 |
Gender | | | |
Male | Ref | | |
Female | -0.059* | 0.026 | 0.023 |
Marital status | | | |
Never married, divorced or widowed | Ref | | |
Married | 0.054* | 0.018 | 0.002 |
Employment status | | | |
Unemployed | Ref | | |
Employed | 0.088* | 0.043 | 0.042 |
Home maker | 0.098* | 0.036 | 0.007 |
Retired | 0.137* | 0.033 | <0.001 |
Having basic health insurance | -0.010 | 0.040 | 0.801 |
Having complementary health insurance | 0.032 | 0.017 | 0.071 |
Presence of any other chronic illness | -0.033 | 0.016 | 0.039 |
Type of fracture | | | |
No Fracture | Ref | | |
Hip | -0.077 | 0.022 | <0.001 |
Clinical Vertebral | -0.075 | 0.027 | 0.005 |
Forearm | -0.010 | 0.020 | 0.611 |